The patient was taken to the operating room
where spinal anesthesia was administered without difficulty. The patient
was prepped and draped in the usual sterile fashion in the dorsal supine
position with a leftward tilt. A Pfannenstiel skin incision was made
with the scalpel and carried through to the underlying layer of fascia
using the knife. The fascia was incised in the midline and extended
laterally using Mayo scissors. Kocher clamps were used to elevate the
superior aspect of the fascial incision, which was elevated, and the
underlying rectus muscles were dissected off bluntly and using Mayo
scissors. Attention was then turned to the inferior aspect of the
fascial incision, which in similar fashion was grasped with Kocher
clamps, elevated, and the underlying rectus muscles were dissected off
bluntly and using Mayo scissors. The rectus muscles were dissected in
the midline.
The peritoneum was identified and entered
bluntly; this incision was extended superiorly and laterally with good
visualization of the bladder. The bladder blade was inserted. The
vesicouterine peritoneum was identified and entered sharply using
Metzenbaum scissors. This incision was extended laterally and the
bladder flap was created digitally. The bladder blade was reinserted.
The lower uterine segment was incised in a transverse fashion using the
scalpel and extended using manual traction and bandage scissors.
Clear fluid was noted. The infant was
subsequently delivered through the hysterotomy without difficulty. The
nose and mouth were bulb suctioned and the cord was clamped and cut. The
infant was subsequently handed to the awaiting NICU team. The placenta
was delivered spontaneously intact with a three-vessel cord noted. The
uterus was exteriorized and cleared of all clots and debris. The uterine
incision was repaired in 2 layers using 0 vicryl sutures. Hemostasis was
visualized. The uterus was returned to the abdomen. The uterine
incision was reexamined and it was noted to be hemostatic. The gutters
were cleared of all clots. The rectus muscles were inspected and noted
to be hemostatic. The fascia was closed with two 0 Vicryl sutures from
each incision angle, the subcutaneous layer was closed with 3-0 vicryl,
and the skin was closed with 3-0 Monocryl. Sponge, lap, and instrument
counts were correct x3. The patient was stable at the completion of the
procedure and was subsequently transferred to the recovery room in
stable condition.
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